Changes In Disparities Research Articles

Changing inequalities in life-expectancy by income in Finland 1997-2020

Abstract Background Previous studies show that in recent decades the changes in mortality disparities between income groups in Finland have been driven by alcohol- and smoking-related causes of death. The gap between the extreme income quintiles narrowed in 2008-14 particularly due to the declining alcohol-related mortality. We analysed the most recent changes in mortality disparities and the causes of deaths behind them. Methods We used register based individual level total population data for ages 30-95+ and yearly follow-up for mortality in 1996-2020 including information on disposable household income quintile in the previous year. Preston method was used for assessing the impact of smoking on mortality. We calculated trends in life expectancy (LE) at age 30 for three-year periods in 1997-2020 and then conducted an Arriaga cause of death decomposition of the gap between highest and lowest quintiles and changes in LE for each quintile from 2015-17 to 2018-20. Results We observed an increasing gap in LE by income due to stagnating LE in the lowest income quintile from 2015 onward among both men and women. Among men the stagnation was observed even after eliminating smoking- and alcohol-related mortality and among women the LE slightly increased after accounting for smoking and alcohol but the gap to the highest quintile increased clearly. Decomposing the change in LE from 2015-17 to 2018-2020 by causes of death showed no specific causes of death behind the stagnation and the widening gap. Among both men and women mortality due to circulatory diseases showed a substantial decline in the lowest quintile whereas in all other causes mortality increased or declined only slightly. Conclusions Inequalities in LE by income are widening again in Finland due to stagnation in the lowest income quintile. Contrary to the prior decades the increasing disparities are not attributable to smoking and alcohol-related deaths but occur in the majority of causes of death. Key messages • After nearly a decade of narrowing mortality inequalities we observed an increasing gap in life expectancy by income mainly due to stagnation in the lowest income quintile. • Contrary to the prior decades the increasing disparities and stagnation of the lowest income quintile are not explained by smoking and alcohol-related deaths but occur in majority of causes of death.

Phased Feature Extraction Network for Vehicle Search Tasks Based on Cross-Camera for Vehicle-Road Collaborative Perception.

The objective of vehicle search is to locate and identify vehicles in uncropped, real-world images, which is the combination of two tasks: vehicle detection and re-identification (Re-ID). As an emerging research topic, vehicle search plays a significant role in the perception of cooperative autonomous vehicles and road driving in the distant future and has become a trend in the future development of intelligent driving. However, there is no suitable dataset for this study. The Tsinghua University DAIR-V2X dataset is utilized to create the first cross-camera vehicle search dataset, DAIR-V2XSearch, which combines the cameras at both ends of the vehicle and the road in real-world scenes. The primary purpose of the current search network is to address the pedestrian issue. Due to varying task scenarios, it is necessary to re-establish the network in order to resolve the problem of vast differences in different perspectives caused by vehicle searches. A phased feature extraction network (PFE-Net) is proposed as a solution to the cross-camera vehicle search problem. Initially, the anchor-free YOLOX framework is selected as the backbone network, which not only improves the network's performance but also eliminates the fuzzy situation in which multiple anchor boxes correspond to a single vehicle ID in the Re-ID branch. Second, for the vehicle Re-ID branch, a camera grouping module is proposed to effectively address issues such as sudden changes in perspective and disparities in shooting under different cameras. Finally, a cross-level feature fusion module is designed to enhance the model's ability to extract subtle vehicle features and the Re-ID's precision. Experiments demonstrate that our proposed PFE-Net achieves the highest precision in the DAIR-V2XSearch dataset.

Do disasters exacerbate socioeconomic inequalities in health among older people?

Disasters can exacerbate socioeconomic health disparities because of differential exposure (e.g., socioeconomically disadvantaged groups are more likely to be exposed to disaster-related trauma) and differential vulnerability (disadvantaged groups are more likely to suffer health consequences of exposure to trauma). We sought to test whether health disparities among older adults widened in the area which was directly affected by the 2011 Great East Japan Earthquake & Tsunami compared to areas which largely escaped tsunami damage. We used data from a cohort of community-dwelling older adults who were directly affected by the 2011 disaster (the Iwanuma Study) and municipalities that were not directly affected (the JAGES parent cohort excluding Iwanuma city). The Iwanuma Study gathered pre-disaster information from participants in 2010 (seven months before the disaster) as well as post-disaster information in 2013, 2016 and 2019 (2.5, 5.5 and 8.5 years after the disaster). Our outcomes were depressive symptoms (GDS) and instrumental activities of daily living (IADL). We examined the pre-versus post-disaster trends in socioeconomic health disparities using the slope index and relative index of inequality. We then conducted a difference-in-difference analysis comparing the pre/post disaster change in health disparities in the “exposed” city (Iwanuma) compared to “control” cities. We found clear pre-disaster socioeconomic inequalities in both GDS and IADL in both the exposed and control cities. However, the magnitude of these inequalities did not change after the disaster on either the absolute or relative scales. The 2011 disaster in northeastern Japan did not exacerbate pre-existing patterns of health inequalities in the older population.

Tracking progress towards equitable maternal and child health in Yunnan: a systematic assessment for the Health Programme for Poverty Alleviation in China during 2015–2020

ObjectivesTo inform the impacts of health programmes which aimed at preventing women and children from being trapped in or returning to poverty because of illness in Yunnan, the main battlefield...

Gender Differences in Daily Time Use: Trends and Educational Differentials

Abstract Using time-diary data collected in 1999, 2009, and 2019, this study documents changes over the last two decades in gender differences in time use for five major daily activities—housework, work outside the home, family care, leisure, and self-care, among Korean mothers and fathers with at least one child aged ten to eighteen. Given the rapid expansion of higher education among women, which outpaces the corresponding expansion among men, trends in gender disparities in daily time use provide a litmus test to evaluate progress toward gender equality. In assessing temporal changes in gender disparities in time use, particular attention is paid to potentially heterogeneous trends across mothers and fathers with different levels of education. The trends in both overall and education-specific time allocations reveal some evidence of progress toward more equal time use between mothers and fathers. However, even in 2019 Korean mothers spent much more time on housework but considerably less time on work outside the home. Moreover, the progress toward gender parity in time use has not been even across levels of education: it has been more evident among those with a bachelor’s degree or higher than their counterparts with lower levels of education.

Temporal assessment of disparities in California COVID-19 mortality by industry: a population-based retrospective cohort study

To assess changes in theCOVID-19 mortality rate and disparities over variants or waves by industry. We identified COVID-19 deaths that occurred between January 2020 and May 2022 among California workers aged 18-64 years using death certificates, and estimated Californians atrisk using theCurrentPopulationSurvey. The waves in deaths were wave 1: March-June 2020, wave 2: July-November 2020, wave 3/Epsilon and Alpha variants: December 2020-May 2021, wave 4/Delta variant: June 2021-January 2022, and wave 5/Omicron variant: February-May 2022. We used Poissonregression to generatewave-specificmortalityrateratios(MRR) and included aninteractiontermbetweenindustryandwave indifferentmodels to assess significanceofthechangeinMRR. In all waves of the pandemic, healthcare, other services, manufacturing, transportation, and retail trade industries had higher mortality rates than the professional, scientific, and technical industry. The healthcare industry had the highest relative rate earlier in the pandemic, while other services, utilities, and accommodation and food services industries had substantial increases in MRR in later waves. Industries that consistently had disproportionate COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes.

Secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019.

To examine the secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019. Data were extracted from the Chinese National Surveys on Students' Constitution and Health from 1985 to 2019, and the heights of a total of 76 554 boys and 75 908 girls aged 18 years were measured. The Mann-Kendall trend test was used to analyze the secular trends in height. Changes in different periods and urban-rural disparities were tested by z-tests and calculating the ratios of the coefficient of variation (CV) of height. The height of Chinese boys and girls aged 18 years increased from 168.21 and 157.10 cm in 1985 to 172.15 cm and 160.11 cm in 2019, respectively, with a larger increase in rural areas. The secular trends in height were the largest for boys from 1995 to 2005 and for girls from 2014 to 2019, and the same results were observed in urban and rural areas. The urban-rural disparities for boys and girls decreased by 1.79 and 0.91 cm, respectively, with significant decreases for boys in all regions and for girls in the eastern region. The overall CVs of height increased by 0.13% and 0.25% for boys and girls, respectively, with the largest increase among rural girls. The height of Chinese adolescents aged 18 years continued to increase between 1985 and 2019. The urban-rural disparities narrowed, and inequalities within rural areas for girls increased.

Trends of Health and Dietary Disparities by Economic Status among Elderly Individuals in Japan from 2004 to 2014: A Repeated Cross-Sectional Survey

This study examines the changes in health and dietary disparities by economic status among elderly individuals in Japan from 2004 to 2014. The study design utilized a repeated cross-sectional approach, using data from the Survey of Attitudes among the Elderly toward Daily Life in 2004 and 2014. Logistic regression analysis was performed with subjective economic status, survey year, and their interactions as independent variables, and self-rated health, dietary satisfaction, and intake of balanced meals as dependent variables. The results revealed that disparities in self-rated health, dietary satisfaction, and intake of a balanced meal were present due to economic status. Furthermore, the disparities in self-rated health, dietary satisfaction, and balanced meal intake by economic status remained unchanged from 2004 to 2014 (P for interaction ≥ 0.05). The findings were consistent in sensitivity analyses conducted on those aged 75 and older, as well as on long-term care insurance recipients.

When "Supplemental" Formula Is Essential: Overcoming Barriers to Hypoallergenic Formula Access for Patients with Food Allergies.

For food-allergic patients, hypoallergenic formulas are medically indicated, often a primary component of the diet and essential for patient safety, health, nutrition, and overall well-being. Yet, food allergy is not included amongst the conditions mandated for coverage under federal health programs and private health insurance. The 2022 infant formula crisis has affected many North American families and has particularly impacted patients with food allergies who rely on a limited number of safe hypoallergenic formula (HF) brands to safely meet their nutritional needs for growth and development. The current formula shortage further highlights the longstanding difficulties faced by families with food allergies in accessing HF. It is in this context that the focus of this manuscript is on chronic barriers faced by patients with food allergies in accessing HF and proposes potential solutions. Legislation to address HF affordability through changes in insurance reimbursement and disparities in access to HF in individuals with food allergy is desperately needed.

COVID-19로 인한 원격 영재수업이 초등과학 영재학생들의 시스템 사고, 과학 동기, 과학 자기 효능감에 미치는 영향

The main purpose of this study was to investigate the effect of online education on gifted students’ systems thinking, science motivation, and scientific self-efficacy during the COVID-19 pandemic. The subjects were 68 elementary science gifted students in 2020. The education program focusing on 15 different subjects was conducted for 90 hours. To investigate the effect on systems thinking, science motivation, and scientific self-efficacy, the preandpost-test design was used. The results of this study were as follows. First, it was revealed that online gifted education was systematically conducted using the university’s existing LMS system, while also reducing students’ group activities and interactions between both students-students and students-instructor within the classroom. Second, online gifted education was effective in gifted elementary science students’ systems thinking and science motivation, however, the effect size was relatively small. Third, educational effects on students’ systems thinking were affected by the district of residence and previous educational experience. Therefore, gifted education is required in consideration of changes in population structure and regional disparities to cultivate human resources needed in the future fast-changing society.

Electrodeposition of Ni-Fe-Co and Ni-Fe Graphene Oxide Alloy Composites

Graphene platelets can impart unique properties to metal matrices, such as enhanced conductivity, mechanical, thermal properties and catalytic activity.1,2 The electrodeposited process to fabricate composite metal matrices has an advantage over other techniques because it can avoid high heat treatment and deformation during fabrication, which can damage the intrinsic structure of graphene plates. Graphene itself is difficult to disperse and incorporate into electrodeposited films, but the oxidized form, having abundant surface functional groups, can be readily dispersed into aqueous solutions. Examples of electrodeposited metals with included graphene oxide (GO) from the electrolyte include elemental deposits such as Ni,3-4 Cu,2,5-6 and Co.7,8 In these studies, graphene oxide addition to the metal matrices promoted enhanced thermal conductivity in Cu,6 grain refinement in Ni4 and Cu5, improved wear resistance of Co7,8 and in the case of Ni changed its preferred crystallographic orientation.3 In alloy electrodeposition, the particle in the electrolyte may also alter the deposit composition through disparate changes in the individual metal ion partial current densities. The alloys containing Fe, Ni and Co from the reduction of their metal ions are of interest for their peculiar behavior, where there tends to be an inhibition of the more noble species reduction reaction (e.g. Ni, Co) in favor of the less noble (Fe) referred to as anomalous codeposition.9 To examine the influence of graphene oxide on the deposit composition, Ni-Fe-Co alloys were galvanostatically electrodeposited from a boric acid-sulfamate electrolyte containing commercial graphene oxide plates. Rotating disk electrodes were used to control the hydrodynamic environment near the cathode. The composition, morphology and structure were examined. The addition of graphene oxide resulted in a change in deposit composition, particularly for Fe and Ni, at low cathodic current densities less than 50 mA/cm2, with the deposit becoming less anomalous with the addition of graphene oxide. The change in composition is thought to be derived from a decrease in adsorbed iron intermediates from an anomalous codeposition model. The partial current densities of Ni-Fe-Co deposition with a measure of ohmically corrected potential are compared with Ni-Fe, Ni and Fe deposition with graphene. References H.G. P. Kumar, M. A.Xavior, Procedia Eng. 97 1033 (2014).J. Biswal, P. R. Vundavilli, and A. Gupt, J. Electrochem. Soc., 167 146501 (2020).D. Kuang, L. Xu, L. Liu, W. Hu, Y. Wu, Appl. Surf. Sci., 273, 484 (2013).J. Li, Z. An, Z. Wang, M. Toda, and T. Ono, ACS Appl. Mater. Interfaces, 8, 3969 (2016). L. P. Pavithra, B. V. Sarada, K. V. Rajulapati, T, N. Rao and G. Sundararajan, Nature Sci Rep 4, 4049 (2014).K. Jagannadham, Metall. Mater. Trans B 43 B 316 (2012).C. Liu, F. Su, J. Liang, Appl. Surf. Sci. 351 889 (2015).A. Toosinezhad, M. Alinezhadfar, S. Mahdavi, Ceram. Int., 46, 16886 (2020).A. Brenner, Electrodeposition of Alloys: Principles and Practice, Academic Press Inc., New York, pp. 399-450 (1963).

Effects of star ratings bonus payments on disparities in medication utilization issues

BackgroundPrevious literature suggested that the consequences of inappropriate medication use may be borne disproportionately by racial/ethnic minorities. It is, therefore, essential to examine if quality improvement initiatives, such as Medicare Part D Star Ratings (Star Ratings), can improve these disparities. ObjectiveTo assess the impact of Star Ratings bonus payments to Medicare Advantage prescription drug plans (MAPDs) implemented in 2012 on racial/ethnic disparities in medication utilization issues (MUIs). MethodsThis study mainly used secondary data from Medicare administrative data linked to Area Health Resources Files for years before (2010–2011) and after MAPD bonus payment implementation (2016–2017). Patients in MAPDs were treated as the intervention group, and those in independent prescription drug plans (PDPs) were used as the comparison group because PDPs were ineligible for bonuses. MUIs targeted and not targeted in Star Ratings were both examined to determine spillover effects. A difference-in-differences approach was applied by including in a logistic regression a 3-way interaction term for dummy variables for racial/ethnic minorities, later period of 2016–2017, and MAPD plan. ResultsRacial/ethnic minorities experienced more MUIs: e.g., the odds of MUIs targeted in Star Ratings among MAPD enrollees were 83% higher (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.71–1.96) for Black than White patients. Black-White disparities in MUIs targeted in Star Ratings decreased 16% more (OR = 0.84; 95% = CI 0.78–0.91) over time among MAPD enrollees than those in PDPs. This pattern was not found for non-Star Ratings measures. Changes in Hispanic-White disparities were similar between MAPD and PDP enrollees for MUIs targeted and not-targeted by Star Ratings. Asian-White and Other-White disparities in MUIs did not experience a higher reduction among MAPD enrollees than PDP enrollees. ConclusionsPart D bonus payments are associated with lower Black-White disparities in MUIs targeted by Star Ratings. However, Part D bonus payments may not have reduced Hispanic-White or Asian-White disparities. Future research should explore the causes of the bonus payments' heterogeneous effects across racial/ethnic groups.

Race, Poverty, and Foster Care Placement in the United States: Longitudinal and Cross-Sectional Perspectives.

Although the connections between race, poverty, and foster care placement seem obvious, the link has not in fact been studied extensively. To address this gap, we view poverty and placement through longitudinal and cross-sectional lenses to more accurately capture how changes in poverty rates relate to changes in placement frequency. The longitudinal study examines the relationship between poverty rate changes and changes in the placement of Black and White children between 2000 and 2015. The cross-sectional study extends the longitudinal analysis by using a richer measure of socio-ecological diversity and more recent foster care data. Using Poisson regression models, we assess the extent to which changes in race-differentiated child poverty rates are correlated with Black and White child placement frequencies and placement disparities. Regardless of whether one looks longitudinally or cross-sectionally, we find that Black children are placed in foster care more often than White children. Higher White child poverty rates are associated with substantially reduced placement differences; however, higher Black child poverty rates are associated with relatively small changes in placement disparity. Black and White child placement rates are more similar in counties with the fewest socio-ecological assets.

Changes in Socioeconomic Disparities for Traffic-Related Air Pollution Exposure During Pregnancy Over a 20-Year Period in Texas

Air pollution presents clear environmental justice issues. However, few studies have specifically examined traffic-related air pollution (TRAP), a source driven by historically racist infrastructure policies, among pregnant individuals, a population susceptible to air pollution effects. How these disparities have changed over time is also unclear but has important policy implications. To examine changes in TRAP exposure by sociodemographic characteristics among recorded pregnancies over a 20-year period. This population-based birth cohort study used descriptive analysis among pregnant individuals in Texas from 1996 to 2016. All pregnant individuals with valid residential address, socioeconomic, and demographic data were included. Individual-level race and ethnicity, education, and maternal birthplace data were extracted from birth certificates and neighborhood-level household income and historical neighborhood disinvestment (ie, redlining) data were assessed via residential addresses. Data analysis occurred between June 2022 and June 2023. The main outcome, TRAP exposure at residential addresses, was assessed via traffic levels, represented by total and truck-specific vehicle miles traveled (VMT) within 500 m; nitrogen dioxide (no2) concentrations from a spatial-temporal land use regression model (ie, vehicle tailpipe emissions); and National Air Toxic Agency cancer risk index from on-road vehicle emissions. TRAP exposure differences were assessed by sociodemographic indicators over the 1996 to 2016 period. Among 7 043 598 pregnant people (mean [SD] maternal age, 26.8 [6.1] years) in Texas from 1996 to 2016, 48% identified as Hispanic or Latinx, 4% identified as non-Hispanic Asian or Pacific Islander, 12% identified as non-Hispanic Black, and 36% identified as non-Hispanic White. There were differences in TRAP for pregnant people by all sociodemographic variables examined. The absolute level of these disparities decreased from 1996 to 2016, but the relative level of these disparities increased: for example, in 1996, non-Hispanic Black pregnant individuals were exposed to a mean (SD) 15.3 (4.1) ppb of no2 vs 13.5 (4.4) ppb of no2 for non-Hispanic White pregnant individuals, compared with 2016 levels of 6.7 (2.4) ppb no2 for Black pregnant individuals and 5.2 (2.4) ppb of no2 for White pregnant individuals. Large absolute and relative differences in traffic levels were observed for all sociodemographic characteristics, increasing over time. For example, non-Hispanic Black pregnant individuals were exposed to a mean (SD) of 22 836 (32 844) VMT within 500 m of their homes, compared with 12 478 (22 870) VMT within 500 m of the homes of non-Hispanic White pregnant individuals in 2016, a difference of 83%. This birth cohort study found that while levels of air pollution disparities decreased in absolute terms over the 20 years of the study, relative disparities persisted and large differences in traffic levels remained, requiring renewed policy attention.

Fossilization can mislead analyses of phenotypic disparity.

Analyses of morphological disparity can incorporate living and fossil taxa to facilitate the exploration of how phenotypic variation changes through time. However, taphonomic processes introduce non-random patterns of data loss in fossil data and their impact on perceptions of disparity is unclear. To address this, we characterize how measures of disparity change when simulated and empirical data are degraded through random and structured data loss. We demonstrate that both types of data loss can distort the disparity of clades, and that the magnitude and direction of these changes varies between the most commonly employed distance metrics and disparity indices. The inclusion of extant taxa and exceptionally preserved fossils mitigates these distortions and clarifies the full extent of the data lost, most of which would otherwise go uncharacterized. This facilitates the use of ancestral state estimation and evolutionary simulations to further control for the effects of data loss. Where the addition of such reference taxa is not possible, we urge caution in the extrapolation of general patterns in disparity from datasets that characterize subsets of phenotype, which may represent no more than the traits that they sample.

Temporal Changes in Racial and Ethnic Disparities in the Utilization of Left Atrial Appendage Occlusion in the United States

Racial and ethnic disparities in the access to left atrial appendage occlusion (LAAO) have been previously described. However, it remains unclear if there have been any changes in these disparities over the years and if the disparities include other racial and ethnic groups not previously studied. We aimed to determine the temporal evolution of the racial and ethnic disparities in the utilization of LAAO from 2016 to 2019. We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2019. International Classification of Diseases, 10th edition codes were used to identify all adult admissions with atrial fibrillation (AF) and those who underwent LAAO. The sample was divided into Asian American and Pacific Islander, Black, Hispanic, White, and other races/ethnicities. Our primary outcome was the utilization of LAAO in patients admitted with a diagnosis of AF. The Cochran-Armitage test was conducted to evaluate the yearly trend in LAAO utilization stratified by race/ethnicity. Multivariable regression analysis was conducted to assess the association of race/ethnicity with multiple end points. A total of 59,415 patients underwent LAAO. The highest yearly increase in LAAO utilization was seen in White patients (trend: 0.16%, p<0.001). Furthermore, compared with White patients, the yearly increase in LAAO utilization was lower in all other racial/ethnic groups. Black patients had the lowest odds of who underwent LAAO (odds ratio=0.45, 95% confidence interval 0.40 to 0.50, p<0.001). In conclusion, significant gaps exist in the utilization of LAAO between racial and ethnic groups, and they appear to continue worsening from 2016 to 2019.

Changes in Geographic Variation and Socioeconomic Inequalities in Esophageal Cancer Mortality in China, 1973-2017.

Geographic variability in esophageal cancer has been reported in China, but data are lacking at the local level. We aimed to investigate changes in disparities in esophageal cancer-related mortality among Chinese counties and whether county-level socioeconomic status was associated with this variation. We used data from a nationwide survey and population-based cancer registries to calculate esophageal cancer-related mortality rates for 782 Chinese counties for the periods of 1973-1975 and 2015-2017. We performed hotspot analysis to identify spatial clusters. We used a multivariable negative binomial regression model to estimate the associations between county-level socioeconomic factors and mortality. From 1973-1975 to 2015-2017, the age-standardized esophageal cancer-related mortality rate decreased from 27 to 8 per 100,000 person-years in China. By county, 577 (74%) of 782 counties experienced decreasing mortality. Geographic disparities in mortality substantially narrowed, with the gap in mortality rates between 90th and 10th percentile counties decreasing from 55 per 100,000 person-years in 1973-1975 to 16 in 2015-2017. However, clusters of elevated rates persisted across north-central China. Rurality [adjusted mortality rate ratio (MRR) 1.15; 95% confidence interval (CI), 1.10-1.21], per capita gross domestic product (adjusted MRR, 0.95; 95% CI, 0.91-0.98), and percentage of people with a high-school diploma (adjusted MRR, 0.86; 95% CI, 0.84-0.87) in a county were significantly associated esophageal cancer-related mortality rates. China has made substantial progress in reducing esophageal cancer-related mortality and disparities, but the intercounty differences remain large. Continued efforts are needed to address the geographical and socioeconomic disparities in esophageal cancer.

Impact of the COVID-19 Pandemic on the Socioeconomic Inequality of Health Behavior Among Japanese Adolescents: A 2-Year Repeated Cross-Sectional Survey.

Although disparities in socioeconomic status in health behaviors have been highlighted globally, they are not well understood in Japanese adolescents. The purpose of this study was to clarify the changes in socioeconomic disparities in adolescents' fundamental health behaviors, such as physical activity, screen time (ST), sleep, breakfast intake, and bowel movement before and during COVID-19. This was a repeated cross-sectional study which used data from the 2019 and 2021 National Sports-Life Survey of Children and Young in Japan. Data of 766 and 725 participants in 2019 and 2021, respectively, were analyzed. Favorable health behaviors were defined as daily moderate to vigorous physical activity (MVPA) of at least 60minutes, ST of less than 2hours, sleep of 8 to 10hours, daily breakfast intake, and bowel movement frequency of at least once in every 3days. We calculated the slope index of inequality and relative index of inequality in each health behavior for equivalent household income levels for assessing absolute and relative economic inequalities. Compliance with MVPA and ST recommendation significantly declined from 20.1% and 23.0% in 2019 to 11.7% and 14.9% in 2021, respectively. The slope index of inequality and relative index of inequality increased in MVPA for income levels, but decreased in daily breakfast in 2019 to 2021. Although the widening and narrowing of the disparity were inconclusive for ST, it exacerbated for the higher-income groups. Our study revealed widening of economic disparities in the achievement of recommended MVPA and narrowing of it in breakfast intake among adolescents before and during COVID-19.

National VQI Initiative Associated With Improved Prescription of Statin and Antiplatelet Medications Across Racial and Ethnic Groups

In 2017, the Vascular Quality Initiative announced the first national initiative intended to improve prescription of antiplatelets and statins. We hypothesized that this national quality initiative would be associated with an increase in prescription of these medications and a decrease in previously noted racial disparities in evidence-based medical management. A retrospective analysis using VQI data from the suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention modules from January 2015 through July 2022 was performed. Inclusion criteria were center participation during the entire study period, age over 18 years, and no documented contraindication to statin or antiplatelet therapy. Exclusion criteria were acute limb ischemia or inpatient death. Frequency of statin prescription by racial group prior to and following announcement of the national initiative were compared. Multivariable logistic regression was performed separately for statin and antiplatelet prescription at discharge. Finally, a time series analysis was performed to assess changes in disparities over time. Overall, 202,900 patients were included, of whom 149,059 identified as White, 35,871 identified as Black or African American, 11,039 identified as Latinx/Hispanic, 2015 identified as Asian, 1031 identified as Indigenous (including American Indian, Alaskan Native, Native Hawaiian, or other Pacific Islander), and 3861 were designated unknown or other, including patients who identified with more than one race. Almost all racial and ethnic groups had a statistically significant improvement in the frequency of any statin prescription and new statin prescription (Table). Moreover, while the difference between groups was statistically significant prior to announcement of the national quality improvement initiative (P < .001), there was no statistically significant difference between groups after (P = .05). On adjusted analysis, following the national quality improvement initiative, patients had an increased odds of both statin (odds ratio [OR], 1.5; P < .001; 95% confidence interval [CI], 1.4-1.6), new statin (OR, 1.4; P < .001; 95% CI, 1.4-1.5), nonaspirin antiplatelet (OR, 1.5, P < .001; 95% CI, 1.5-1.6), and new nonaspirin antiplatelet prescription (OR, 1.5, P < .001; 95% CI, 1.5-1.6). There was no statistically significant difference in the odds of new aspirin prescription. A time series analysis demonstrated continued improvement of statin prescription for all racial and ethnic groups, with a convergence around 90% (Figure). The first national VQI quality initiative was associated with a reduction in the disparities in statin prescription and nonaspirin antiplatelet prescription across all ethnic groups. These findings highlight the impact VQI-based national quality initiatives may have on racial and ethnic disparities in medical management.TableStatin prescription at dischargeAny statin prescriptionNew statin prescriptionPre-Post-DifferenceP valuePre-Post-DifferenceP valueWhite80.5%88.2%+7.8%.00126%37.8%+11.8%.001Black or African American79.7%88.2%+8.6%.00129.8%42.2%+12.4%.001Latinx/Hispanic82%87.7%+5.7%.00131.9%38.9%+7%.001Unknown or other77.6%86.6%+9%.00127.2%38.7%+11.5%.001Asian83.8%87%+3.2%.0527.9%37.9%+10%.05Indigenous (including American Indian, Alaskan Native, Native Hawaiian, or other Pacific Islander)77.2%86.5%+9%.00133.3%39.5%+6.2%.33 Open table in a new tab

Sex Disparities in Diagnostic Evaluation and Revascularization in Patients With Acute Myocardial Infarction-A 15-Year Nationwide Study.

Background Although sex disparities in the diagnostic evaluation and revascularization of patients with acute myocardial infarction are well documented, no study has evaluated longitudinal trends in these disparities. Methods and Results Using the National Inpatient Sample from 2005 to 2019, 9 259 932 patients with acute myocardial infarction were identified. We divided 15 years into five 3-year periods. The primary objective was to evaluate sex-based trends in the use of diagnostic angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG) among patients with non-ST-segment-elevation myocardial infarction and ST-segment-elevation myocardial infarction (STEMI) over 15 years. The secondary objective was to evaluate sex disparities in mortality, length of stay, and cost. For non-ST-segment-elevation myocardial infarction, we saw a small reduction in sex disparity in the use of all diagnostic angiography in period 5 versus period 1 (4% versus 5.3%; P<0.01), no change in sex disparity in percutaneous coronary intervention use in period 5 versus period 1 (5.6% versus 5%; P=0.16), and a widening sex disparity in CABG in period 5 versus period 1 (5.4% versus 4.4%; P<0.01). However, we noted decreasing sex disparities in the use of diagnostic angiography, percutaneous coronary intervention, and CABG for ST-segment-elevation myocardial infarction in mostly all periods compared with period 1 (P<0.05, all comparisons), but differences still existed in period 5. Risk-adjusted in-hospital mortality was higher after CABG for non-ST-segment-elevation myocardial infarction and after percutaneous coronary intervention and CABG for ST-segment-elevation myocardial infarction in women than men. Conclusions Despite variable trends in sex disparities in diagnostic and revascularization procedures for acute myocardial infarction, disparities still exist.